Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214244
Report Date: 08/08/2017
Date Signed 08/08/2017 04:25:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:VENTURA BRANCH - FAMILY Y JUNIOR HIGH PROGRAMFACILITY NUMBER:
566214244
ADMINISTRATOR:JULIE O'BRIENFACILITY TYPE:
840
ADDRESS:3760 TELEGRAPH RD.TELEPHONE:
(805) 642-2131
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:18CENSUS: 0DATE:
08/08/2017
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Julie O'Brien, Youth Programs DirectorTIME COMPLETED:
04:27 PM
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LPA Stacie Merkes made an unannounced visit to this center for the purpose of delivering an amended report for signature. On 7/27/17 this LPA contacted Ms O'Brien to announce site 566207389 was granted an appeal and the report would be mailed for signature.

On 8/7/17 this LPA was contacted by Ms O'Brien to state she had not received the report. All the Ventura Branch YMCA sites operate exempt for the summer therefore LPA made a collateral visit to this site as this is where Ms O'Brien's office is located.

LPA delivered a copy of the amended report to the Director and was provided a signed copy for the file.
SUPERVISOR'S NAME: Patricia S. GutierrezTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Stacie MerkesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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